■大量不可修复的肩袖撕裂的手术处理仍然存在争议。关节镜清创术(AD)已显示出有希望的结果,尤其是在65岁以上的人群中;然而,对于各种AD程序的好处没有共识。这项系统评价的目的是评估AD联合肩峰下减压治疗患者的功能中期到长期结果。肱二头肌肌腱切开术,结节成形术,或者是行囊切除术,没有修复肩袖撕裂。
■在PubMed中进行了全面搜索,护理和相关健康文献累积指数(CINAHL),和Cochrane数据库,用于报告大量肩袖撕裂的AD临床结局的研究。使用非随机研究方法学指数(MINORS)标准由两名独立的评审员确定质量。对于患者报告的结果,计算汇总频率加权平均值和标准偏差。
■包含643名患者和662名肩膀的16篇文章符合资格标准。手术时的平均年龄为65.9±4.4岁,平均随访期为46.5±27.3个月。术后所有患者报告的结果评分均有显着的临床显着改善:常数70.4±8.9(P值=.06),加州大学,洛杉矶超声检查26.7±5.2(P值=.001),美国肩肘外科医生评分71.7±2.1(P值=.12),手臂的残疾,肩膀,手评分35.3,视觉模拟评分1.7±0.9。49名患者(7%)需要再次手术,最常见的是反向全肩关节成形术治疗肩袖关节病。
■关节镜下清除术联合肩峰下减压术,结节成形术,肩峰下囊切除术,肱二头肌肌腱切开术,用于治疗大量不可修复的肩袖撕裂,对于65岁以上的低需求人群,希望通过功能的大幅增加来缓解疼痛,从而在中长期随访中产生良好的功能结果并改善疼痛。
UNASSIGNED: Surgical management of massive irreparable rotator cuff tears remains controversial. Arthroscopic debridement (AD) has shown promising results especially in the population older than 65 years; however, there is no consensus on the benefits of various AD procedures. The aim of this systematic review was to evaluate the functional midterm to long-term outcomes in patients treated with AD in combination with subacromial decompression, biceps tenotomy, tuberoplasty, or bursectomy, without repair of the rotator cuff tear.
UNASSIGNED: A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane databases for studies reporting clinical outcomes of AD of massive rotator cuff tears. Quality was determined using the Methodological Index for Nonrandomized Studies (MINORS) criteria by two independent reviewers. Pooled frequency-weighted means and standard deviations were calculated for patient-reported outcomes.
UNASSIGNED: Sixteen articles containing 643 patients and 662 shoulders met the eligibility criteria. The mean age at the time of surgery was 65.9 ± 4.4 years with a mean follow-up period of 46.5 ± 27.3 months. There was notable clinically significant improvement across all patient-reported outcome scores postoperatively: Constant 70.4 ± 8.9 (P value = .06), University of California, Los Angeles ultrasonography 26.7 ± 5.2 (P value = .001), American Shoulder and Elbow Surgeons score 71.7 ± 2.1 (P value = .12), Disabilities of the Arm, Shoulder, and Hand score 35.3, and visual analog score 1.7 ± 0.9. Forty-nine patients (7%) required reoperation, which most commonly was a reverse total shoulder arthroplasty for the development of rotator cuff arthropathy.
UNASSIGNED: Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy, for treatment of massive irreparable rotator cuff tears, produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function.